198201977-1-5-2022-11-AS-MVAO-CC4QU4-20220301112807

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198201977
Report Date: 01/05/2022
Date Signed: 01/05/2022 08:50:12 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/27/2021 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20211227121908

FACILITY NAME:	SANCTUARY, THE		FACILITY NUMBER:	198201977
ADMINISTRATOR:	CATHERINE RAYMUNDO		FACILITY TYPE:	740
ADDRESS:	21410 MADRONA AVENUE		TELEPHONE:	(424) 558-3134
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90503
CAPACITY:	6	CENSUS: 5	DATE:	01/05/2022
		UNANNOUNCED	TIME BEGAN:	09:36 AM
MET WITH:	CATHY RAYMUNDO		TIME COMPLETED:	03:59 PM

ALLEGATION(S):

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Licensee does not have facility license posted accessible to public view.
Staff exposed resident to COVID.
Facility bathroom is inoperable.

INVESTIGATION FINDINGS:

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On 01/05/22, Licensing Program Analysts (LPAs) Ernand Dabuet and Gail Johnson conducted an initial 10-day unannounced complaint visit at this facility, LPAs were greeted by Licensee Cathy Raymundo.

LPAs explained the purpose of today's visit is to gather information and interview staff and residents.

The investigation consisted of the following: LPAs obtained copies of the roster for residents and staff. Interviews were conducted with Resident #1-#5 (R1-R5), staff #1-#3 (S1-S3), and witnesses #2-#3 (W2-W3). A review of (R1's) service records and other pertinent documents pertinent to the allegations.

Report continues on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20211227121908

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

FACILITY NAME: SANCTUARY, THE	FACILITY NUMBER: 198201977
	VISIT DATE: 01/05/2022

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Licensee does not have facility license posted accessible to public view.
The details of the complaint state the facility's Community Care Licensing (CCL) is not accessible for public view. The complainant alleges that the licensee does not have the facility's license posted up at the facility and that the operator is operating as a hospice board and care. The Department conducted an in-person inspection visit on 01/05/22 and observed the (CCL) license available for public viewing. The (CCL) license is affixed on a bulletin board along with other (CCL) licensing documents. The bulletin board is situated 10 feet from the facility's entrance and is visible. An interview with licensee staff #1 (S1) states the (CCL) license has been affixed in the same location for 24 years, and it has not been removed. An interview with witnesses #2-#3 (W2-W3) both present during the inspection also verified that they were aware the facility is licensed by the State, and that (CCL) license has been prominent for public view. The facility is approved for a hospice waiver for (5) residents. Currently, the facility has three (3) hospice residents in care and has not exceeded the hospice waiver. Based on the information gathered, there is no evidence to support the allegation mentioned above.

Allegation: Staff exposed resident to COVID.
It is alleged that staff exposed resident #1 (R1) to COVID. The complainant states the staff was negligent and exposed (R1) to COVID. An interview with the complainant states she was uncertain of the time when (R1) was exposed, however, she said it was not in recent months but, was approximately in December 2020. The complainant was unable to provide detailed knowledge of this allegation. The facility has remained COVID-free since the start of the COVID in March 2020. The Department has no history of COVID cases from this facility. An interview with licensee staff #1 (S1) says they adhere to the Community Department of Social Services (CDSS), Los Angeles Department of Public Health (LAPH), and Center for Disease Control (CDC). The facility has on file a (CCL) Mitigation Plan approved by the Department on 03/27/21. The facility conducts COVID screening of visitors, staff, and residents. (S1) maintains documentation of test results and vaccinations of residents and staff. (S1) claim this allegation is false and that (R1) has never tested positive or been exposed to COVID. Based on the information gathered, there is no evidence to support the allegation mentioned above.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20211227121908

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

FACILITY NAME: SANCTUARY, THE	FACILITY NUMBER: 198201977
	VISIT DATE: 01/05/2022

NARRATIVE

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Allegation: Facility bathroom is inoperable.
The details of the complaint states the bathroom in resident #1 (R1's) room is inoperable. The complainant states the bathroom in (R1's) is nonfunctional with the toilet broken for four to five months. The Department inspected all bathrooms were found to be within Title 22 regulations and were clean and operational. The Department did not detect the toilets, sinks, faucets, showers, and cabinet storages broken. The Department tested the plumbing fixtures and found them to be in working condition. An interview with witnesses #2-#3 verified the facility is in adequate condition and has never observed it to be in disrepair. (W2) comments she has been visiting at this facility for four and half years and has never experienced household fixtures not working at this facility. The licensee reports this allegation is fabricated and that bathrooms have not been in neglect for repairs. The licensee states it would be improbable to have a toilet not working properly for that extended months as the complainant had alleged. Based on the information gathered, there is no evidence to support the allegation mentioned above.

Based on interviews, observation, photographs and record reviews, the Department did not find sufficient evidence to support allegations, "Licensee does not have facility license posted accessible to public view", "Staff exposed resident to COVID", and "Facility bathroom is inoperable".

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are UNSUBSTANTIATED.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

LIC9099 (FAS) - (06/04)

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